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L hrt cath w/l ventriculogram, ivus eval of l/anterior descending pre/post stenting

  1. Default L hrt cath w/l ventriculogram, ivus eval of l/anterior descending pre/post stenting
    Medical Coding Books
    Again new to cardiology, I will try to code this but am in need of some help I'm sure.

    PROCEDURE: L/HRT CATH W/L VENTRICULOGRAM
    IVUS EVAL OF L.ANTERIOR DESCENDING PRE/POST STENTING
    PTCA/STENTING MIDE LEFT ANTERIOR DESCENDING
    INTRACORONARY NITROGLYCERIN INJECTIONS DURING PROCEDURE

    DESCRIPTION: Lidocaine injected into right groin w/o complications. Sedlinger technique,
    6 french sheath was placed in right common femoral artery w/o
    complications. Exchanges were done over a wire. Judkins right
    and left catheters were then used to engage the coronary ostia.
    Judkins JL-5cm catheter was required to engage left main.
    Pigtail placed in the aorta over a wire and the aortic valve was
    crossed. Left ventriculogram and left ventricular end diatolic
    pressure was measured. The gradient across the aortic valve
    was measured. Angio seal closure device was used to close
    the right groin w/o complications.

    HEMODYNAMIC: BP ranged from 149/87 to 108/60 and HR was 70. No gradient
    across aortic valve on retrograde pullback.

    INTERVENTIONAL PROCEDURE: Confirming an intermediate 60% lesion in the left
    anterior descending, began to proceed with an
    intravascular ultrasound eval of this lesion. Done
    with intravenous heparin . The IVUS
    demonstrated a cross sectional area @ the
    tighest portion of 3.1 to 3.3mm sq 65% stenosis.
    Proceeded with angioplasty and stenting of this
    lesion. EBU 4.5 quide was used over a floppy wire,
    since already present. Angioplastied the lesion
    using 3.0 x 12 angioplasty balloon. Following a 3.0 x 15
    Xience stent deployed to high atmospheric pressure.
    Lesion postdilated using 3.0 x10 mm postdilation
    noncompliant balloon. Final IVUS showed excellent
    stent expansion. no evidence of proximal or distal
    dissection and final cross sectional are of 5.9 mm sq.

    Here is my analysis:

    L/HRT CATH W/L VENTRICULOGRAM............93452-59
    IVUS.............................................. ............37250-59
    PTCA L/ANTERIOR DESCENDING...................92982-LD
    STENTING L/ANTERIOR DESCENDING............92980-LD
    INTRACORONAY NITROGLYCERIN INJ............37202-59

    Again you help is greatly appreciated.

  2. #2
    Post My opinion
    I would code only following:

    92980-LD - LAD stenting (including angioplasty)
    93452-51 - Lt. heart cath with vgram
    92978 – IVUS

    Rest bundled.

    HTH.
    Girish Dadhich, CPC

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